ARGE RAVIADI M 22010111130067 LAPORAN KTI BAB 0

HUBUNGAN GANGGUAN PENDENGARAN DENGAN
KEMAMPUAN BAHASA PADA ANAK SINDROM DOWN

LAPORAN HASIL PENELITIAN
KARYA TULIS ILMIAH
Diajukan sebagai syarat untuk mengikuti ujian hasil
Karya Tulis Ilmiah mahasiswa program strata-1 kedokteran umum

ARGE RAVIADI MUHAMMAD
22010111130067

PROGRAM PENDIDIKAN SARJANA KEDOKTERAN
FAKULTAS KEDOKTERAN
UNIVERSITAS DIPONEGORO
2015

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KATA PENGANTAR

DAFTAR ISI

HALAMAN JUDUL................................................................................................ i
LEMBAR PENGESAHAN PROPOSAL KTI ...... Error! Bookmark not defined.
PERNYATAAN KEASLIAN ................................ Error! Bookmark not defined.
KATA PENGANTAR ........................................... Error! Bookmark not defined.
DAFTAR ISI .......................................................................................................... vi
DAFTAR TABEL ................................................................................................... x
DAFTAR GAMBAR ............................................................................................. xi
DAFTAR LAMPIRAN ......................................................................................... xii
DAFTAR SINGKATAN ..................................................................................... xiii
ABSTRAK ........................................................................................................... xiv
ABSTRACT .......................................................................................................... xv
BAB I PENDAHULUAN ....................................................................................... 1
1.1 Latar belakang ................................................................................................... 1
1.2 Permasalahan penelitian .................................................................................... 3
1.3 Tujuan penelitian ............................................................................................... 3

1.3.1 Tujuan umum ................................................................................................. 3
1.4 Manfaat penelitian ............................................................................................. 4
1.5 Keaslian penelitian ............................................................................................ 4
BAB II TINJAUAN PUSTAKA............................................................................. 6
2.1 Sindrom down ................................................................................................... 6

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2.1.1 Manifestasi klinis sindrom down ................................................................... 7
2.1.2 Kondisi spesifik sindrom down...................................................................... 8
2.2 Sistema auditorik manusia ................................................................................ 9
2.2.1 Anatomi dan fisiologi pedengaran normal ..................................................... 9
2.2.1.1 Mekanisme konduksi suara ....................................................................... 10
2.2.1.1.1 Telinga luar ............................................................................................ 10
2.2.1.1.2 Telinga tengah ........................................................................................ 12
2.2.1.2 Mekanisme transduksi suara ..................................................................... 14
2.2.1.2.1 Telinga dalam ......................................................................................... 14
2.2.2 Patologi pendengaran manusia..................................................................... 16
2.2.2.1 Conductive hearing loss (CHL) ................................................................ 17
2.2.2.2 Sensory-neural hearing loss (SNHL) ........................................................ 18

2.2.2.3 Mixed hearing loss (MHL) ....................................................................... 18
2.2.3 Pendengaran pada anak sindrom down ........................................................ 19
2.2.4 Screening pendengaran ................................................................................ 20
2.3 Kemampuan berbicara dan berbahasa anak normal ........................................ 21
2.3.1 Kemampuan berbicara dan berbahasa anak sindrom down ........................ 22
2.4 Hubungan ISPA dengan Gangguan Berbicara dan Berbahasa ...................... 26
2.5 Hubungan Faktor Stimulasi dengan Perkembangan Berbicara dan Berbahasa
............................................................................................................................... 26
2.6 Hubungan Faktor Retardasi Mental dengan Perkembangan Berbicara dan
Berbahasa ............................................................................................................. 27
BAB III KERANGKA TEORI, KERANGKA KONSEP, HIPOTESIS .............. 28
3.1 Kerangka teori ................................................................................................. 28
3.2 Kerangka konsep ............................................................................................. 29

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3.3 Hipotesis.......................................................................................................... 29
3.3.1 Hipotesis mayor ........................................................................................... 29
BAB IV METODOLOGI PENELITIAN ............................................................. 30
4.1 Ruang lingkup penelitian ................................................................................ 30

4.2 Tempat dan waktu penelitian .......................................................................... 30
4.3 Jenis dan rancangan penelitian ........................................................................ 30
4.4 Populasi dan sampel penelitian ....................................................................... 30
4.4.1 Populasi target .............................................................................................. 30
4.4.2 Populasi terjangkau ...................................................................................... 30
4.4.3 Sampel .......................................................................................................... 31
4.4.3.1 Kriteria inklusi .......................................................................................... 31
4.4.3.2 Kriteria eksklusi ........................................................................................ 31
4.4.4 Cara sampling............................................................................................... 31
4.4.5 Besar sampel ................................................................................................ 31
4.5 Variabel penelitian .......................................................................................... 32
4.5.1 Variabel bebas .............................................................................................. 32
4.5.2 Variabel terikat ............................................................................................. 32
4.5.3 Variabel perancu .......................................................................................... 32
4.6 Definisi operasional ........................................................................................ 32
4.7 Cara pengumpulan data ................................................................................... 33
4.7.1 Bahan dan alat .............................................................................................. 33
4.7.2 Jenis data ...................................................................................................... 33
4.7.3 Cara kerja ..................................................................................................... 33
4.8 Alur penelitian ................................................................................................. 34

4.9 Analisa data ..................................................................................................... 35

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4.10 Etika penelitian.............................................................................................. 35
4.11 Jadwal penelitian ........................................................................................... 35
BAB V HASIL PENELITIAN ............................................................................. 36
5.1 Karakteristik Subjek Penelitian ....................................................................... 36
5.1.1 Fungsi pendengaran subjek penelitian ......................................................... 37
5.1.2 Tipe gangguan pendengaran subjek penelitian ............................................ 38
5.2 Analisis interferensial ..................................................................................... 39
5.2.1 Hubungan derajat gangguan pendengaran dengan derajat perkembangan
bahasa (DDST) ...................................................................................................... 39
5.2.2 Hubungan gangguan pendengaran dengan perkembangan bahasa (DDST) 40
5.2.3 Hubungan Periode Umur dengan Perkembangan Bahasa (DDST).............. 40
BAB VI PEMBAHASAN ..................................................................................... 42
BAB VII SIMPULAN DAN SARAN .................................................................. 47
7.1 Simpulan ......................................................................................................... 47
7.2 Saran ................................................................................................................ 47
DAFTAR PUSTAKA ........................................................................................... 48

LAMPIRAN

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DAFTAR TABEL

Tabel 1. Keaslian Penelitian…………………………………….………...…….....4
Tabel 2. Gambaran Fisik Sindrom Down..……………………….......….…..……8
Tabel 3. Kondisi Spesifik Sindrom Down……………………..…….............…...8
Tabel 4. Klasifikasi Gangguan Pendengaran Menurut WHO……………………17
Tabel 5. Periode Perkembangan Bahasa Anak Normal.........................................21
Tabel 6. Perbandingan Perkembangan Bahasa Anak Normal dengan Anak
Sindrom Down.........................................................................................23
Tabel 7. Definisi Operasional………………………………….………...……....32
Tabel 8. Jadwal Penelitian…………………………………….………...……......35
Tabel 9. Karakteristik Subjek Penelitian................................................................36
Tabel 10. Kategori Fungsi Pendengaran Secara Umum........................................38
Tabel 11. Distribusi Tipe Gangguan Pendengaran................................................38
Tabel 12. Hubungan Fungsi Pendengaran dengan Perkembangan Bahasa
(DDST)..................................................................................................40


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DAFTAR GAMBAR

Gambar 1. Telinga Luar.........................................................................................11
Gambar 2. Pinna (Auriculla).............……………….....………………………....11
Gambar 3. Telinga Tengah………………………...............................…………..13
Gambar 4. Tulang Pendengaran Telinga Tengah...................................................14
Gambar 5. Cavum Tymphani.................................................................................14
Gambar 6. Potongan Melintang Choclea (A), Organa Corti (B)..........................16
Gambar 7. Kerangka Teori.....................................................................................28
Gambar 8. Kerangka Konsep.................................................................................29
Gambar 10. Nilai Rerata (Mean) DQ Perkembangan Bahasa (DDST).................39

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DAFTAR LAMPIRAN

Lampiran 1. Ethical Clearance..............................................................................52

Lampiran 2. Surat Ijin Penelitian dan Peminjaman Data Rekam Medis...............53
Lampiran 3. Surat Pernyataan Penelitian di RSUP Dr. Kariadi Semarang ..........54
Lampiran 4. Data output SPSS Hasil Penelitian....................................................55
Lampiran 5. Biodata Peneliti..................................................................................61

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DAFTAR SINGKATAN

AABR

: Automated Auditory Brainstem Response

BERA

: Brainsteam Electric-Response Audiometry

CHL

: Conductive Hearing Loss


dB

: Decibels

DDST

: Denver Developmental Screening Test

DQ

: Developmental Quotient

Hz

: Hertz

IQ

: Intelligence Quotient


ISPA

: Infeksi Saluran Pernafasan Atas

KEPK

: Komisi Etik Penelitian Kesehatan

KHz

: Kilo Hertz

MHL

: Mixed Hearing Loss

NHS

: Newborn Hearing Screening


OAE

: Otoacoustic Emission

OME

: Otitis Media Efusi

POTADS

: Persatuan Orang Tua Anak dengan Down Syndrome

PTA

: Pure Tone Audiometry

Riskesdas

: Riset Kesehatan Dasar

RSUD

: Rumah Sakit Umum Daerah

RSUP

: Rumah Sakit Umum Pusat

SLBN

: Sekolah Luar Biasa Negeri

SNHL

: Sensory-Neural Hearing Loss

WHO

: World Health Organization

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ABSTRAK

Latar Belakang: Sindrom Down adalah kelainan kromosom genetik yang disebut
trisomi. Pasien sindrom Down memiliki ekstra kromosom 21. Hal ini dikarenakan
adanya gagguan pembelahan kromosom yang disebut non-disjungsi atau
aneuploidi. Bertambahnya kromosom berdampak pada ketidak seimbangan
genetik, retardasi mental dan terganggunya fungsi fisik, intelektual bahkan
fisiologi tubuh. Beberapa gangguan atau masalah kesehatan terbesar yang dialami
oleh anak-anak dengan sindrom Down adalah gangguan pendengaran dan
perkembangan bahasa gangguan.
Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan antara gangguan
pendengaran dengan perkembangan bahasa pada anak sindrom Down.
Metode: Penelitian ini menggunakan metode analytic observasional
retrospektive. Data diambil dari catatan medis pasien sindrom Down di RSUP dr.
Kariadi pada tahun 2008-2015. Sampel adalah anak sindrom Down yang
melakukan kontrol di RSUP dr. Kariadi Semarang. Pengambilan data berupa data
karakteristik, data fungsi pendengaran kedua telinga yang dilakukan pemeriksaan
BERA , dan data perkembangan bahasa yang diperiksa dengan DDST. Uji
statistik dilakukan dengan uji Chi-square dan uji Fisher .
Hasil: Penelitian ini menggunakan 32 sampel anak sindrom Down. Sebanyak 8
(25%) subjek dengan pendengaran normal dan 24 (75%) adalah subjek dengan
gangguan pendengaran. Analisis hubungan gangguan pendengaran ringan dengan
perkembangan bahasa (DDST) mempunyai nilai p = 1,00. Hubungan gangguan
pendengaran sedang dengan perkembangan bahasa (DDST) mempunyai nilai p =
0,538. Dan hubungan gangguan pendengaran berat – sangat berat dengan
perkembangan bahasa (DDST) mempunyai nilai p = 0,569.
Kesimpulan: Tidak ada hubungan gangguan pendengaran pada perkembangan
bahasa pada anak sindrom Down.
Kata kunci: Down syndrome, gangguan pendengaran, perkembangan bahasa
(DDST).

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ABSTRACT

Background: Down syndrome is a genetic chromosomal disorder called trisomy.
Patients with Down syndrome have an extra chromosome 21. This is because of
non-disjunction or aneuploidy of the chromosomes. Increased chromosomal
imbalance impact on genetic, mental retardation and disruption of physical
functions, intellectual and even physiology. Some of the largest health problems
experienced by children with Down syndrome are hearing impairment and
impaired language development.
Aim: To analyze the correlation between hearing impairment and language
development in Down Syndrome children.
Methods: This study uses an observational analytic retrospective. Data taken
from the medical records of Down Syndrome patients in the dr Kariadi Hospital
Semarang in 2008-2015. The data include characteristic of the subject, hearing
function on both ears with BERA examination, and examined language
development with DDST. Statistical tests performed by Chi-Square test and
Fisher's exact test.
Results: This study used 32 samples of children with Down syndrome. A total of 8
(25%) us subjects with normal hearing and 24 (75%) is subjects with hearing
impairment. Analysis of the relationship beetwen mild hearing impairment and
the development of language (DDST) has a value of p = 1.00. Analysis of the
relationship beetwen moderate hearing impairment and the development of
language (DDST) has a value of p = 0.538. And the analysis of the relationship
beetwen severe – profound hearing impairment and the development of language
(DDST) has a value of p = 0.569.
Conclusion: There is no correlation between hearing impairment and language
development in children with Down syndrome.
Keywords: Down syndrome, hearing impairment, language development (DDST).

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